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Objective: Breast conserving surgery is an excellent option in the treatment of breast cancer. To achieve a good result with this modality, a surgeon needs to identify and excise the tumor with adequate margins. The radiofrequency identification (RFID) technique is a wireless localization technique used for intraoperative breast lesion identification. We assessed the efficacy and outcomes of the RFID technique in breast cancer patients at our institution. Materials and Methods: This is a single institution, retrospective study (BSMH 22-02X-MWH) of 73 patients. We analyzed the medical records of women with biopsy-proven breast cancer from June 2020 to August 2022; participants received surgical care at Mercy Health West Hospital. Data collected included demographics, clinicopathological characteristics, and surgical procedure. The primary objective was to determine the safety and efficacy of RFID. The secondary objective was to assess the impact of obesity and breast density on the RFID outcomes. Results: A total of 73 female patients met the eligibility criteria with stage I (59%) and grade 1 (51%) breast cancer with mean age of at diagnosis of 66.8 years and mean body mass index of 31.4 kg/m2. Patients had invasive ductal carcinoma (61%), hormonal positive (56%), and human epidermal growth factor receptor 2 negative (68%) disease. All RFID tags were placed under image guidance with 100% accuracy of placement with no evidence of migration or procedure revision. Ninety percent of patients had free surgical margins and only seven patients needed margin re-excision with successful removal of the lesion and the tag. Conclusion: RFID localization technique is a safe, effective and reliable procedure that results in favorable patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

This study was designed to determine the prevalence of Chlamydia pneumoniae in carotid artery plaques. Although there have been numerous studies evaluating coronary plaques for this bacterium fewer studies have assessed noncoronary vasculature. In addition we wished to evaluate whether correlation exists between the presence of C. pneumoniae in carotid plaques and established risk factors for atherosclerosis. Sixty intact carotid artery plaques removed during surgery (carotid endarterectomy) were formalin-fixed and paraffin-embedded according to conventional techniques. These samples were evaluated by polymerase chain reaction analysis to detect presence of C. pneumoniae DNA. Results were tabulated and compared against established risk factors for atherosclerosis: diabetes, hypertension, hyperlipidemia, age, and smoking. Forty-two (70.0%) of the 60 plaques that were evaluated tested positive for the presence of C. pneumoniae DNA by polymerase chain reaction analysis. In the sample defined as being from heavy smokers (greater than 15-pack-year history) 33 (94.3%) of 35 plaques tested positive whereas two (5.7%) tested negative. This correlation demonstrated statistical significance (P = 1.36 x 10[sup -6], two-tailed Fisher exact test). Presence of C. pneumoniae in carotid plaques demonstrated no statistically significant correlation with diabetes, hypertension, or hyperlipidemia. Age as a risk factor was examined but not statistically evaluated because of the narrow range within our patient sample. Analysis of the data reveals that C. pneumoniae is present in large numbers of atheromatous plaques as is consistent with emerging data. What is interesting though is that 33 (94.3%) of the 35 smokers had plaques that tested positive for the bacterium as opposed to only nine (36.0%) of the 25 nonsmokers. Identification of specific populations exhibiting a high prevalence of C. pneumoniae may serve to focus future studies. Ongoing investigation will seek to deter... [ABSTRACT FROM AUTHOR]

The article presents the case study of an 80-year-old woman who was presented to the emergency department of a hospital soon after the onset of shortness of breath. The computed tomographic analysis of her chest showed a pulmonary embolism and an apparent atrial mass. Subsequent transesophageal echocardiographic analysis revealed a large, mobile, right atrial mass that was tortuous in appearance and intermittently traversed the tricuspid valve. The patient was operated and a median sternotomy was performed and cardiopulmonary bypass was instituted. The clot was extracted, and a separate pulmonary-artery thrombectomy was performed, and a Greenfield venacaval filter was placed on the following day and warfarin therapy was subsequently initiated.

INTRODUCTION: Recovery plays a crucial role in athletic success, yet it is one of the least understood and under-researched areas of sport performance. This study examined the impact of recovery duration on subsequent performance over 2000m on a rowing ergometer using a Concept II-D, (Morrisville, VT) ergometer. METHODS: Ten well-trained, collegiate women rowers (age: 19.4+/- 1.2 yrs, ht: 175.1+/- 5.6, body mass: 63.6+/- 8.5 kg) participated in this investigation. In a randomized, crossover design all subjects completed 2 race trials in each of 2 experimental sessions, passively recovering for either 6 or 24 hours in between trials. Data were collected every 500m; including average power, stroke rate, and 500m split time as well as heart rate and rating of perceived exertion. A one-way analysis of variance (ANOVA) with repeated measures was used to analyze these data and to compare the baseline rowing trials with the subsequent recovery trial of either 6 or 24 hours after the first simulated race of the two day sequence. When appropriate a Fishers LSD post-hoc test was used to determine pair wise differences between the means. Significance in this study was set at P ≤ 0.05. RESULTS: Results showed no statistically significant differences in any of these variables with either the 6 or 24 hour recovery condition or across 500m time points within each race trial. No differences were seen for power changes across the race trials. (see Figure 1). For the RPE values at each 500m segment there were no differences between the recovery time points for any given race segment. However, as might be expected RPE values increased over the course of the race to almost maximal values for the 6-20 scale. The 500m segment RPE values were significantly less than their corresponding values at the end of the 1500m and 2000m race segments. Additionally, the 1000m segment was significantly less than the 2000m race segment, indicating an incremental perceptual strain as the race continued no matter the race trial or recovery time point that was measured. An increased heart rate was observed between the 500m race segment and corresponding values for the 1500m and 2000m race segments. No differences were observed within the race segment for 6 or 24 hour recovery time points. Furthermore, no significant differences were observed between the corresponding race segments of 1000m to 2000m, indicating a relative steady state in physiological function. Interestingly, the heart rate and RPE were not significantly correlated (r = -0.008, P ≤ 0.05). This further supports the separation of physiological strain from psycho-perceptual demands in this 2K race. CONCLUSIONS: Despite the lack of significant physical fatigue, there was evidence of increased perceptual strain during each race trial, as average power was maintained throughout despite increases in ratings of perceived exertion. PRACTICAL APPLICATIONS: From a practical perspective, it appears that it did not matter if rowers had 6 or 24 hours recovery time between subsequent “all-out” 2000m performances on a rowing ergometer. This seems to demonstrate not only the highly trained nature of collegiate rowers but also their mental toughness and ability to psychologically absorb and tolerate the physical stress of “all out” 2000m rowing performance. [ABSTRACT FROM AUTHOR]

PURPOSE: To date no study has examined the influence of different types of resistance exercise workouts on EEG cortical activity in the brain. The purpose of this study was to uncover topographical characteristics of cortical activity during different resistance exercise (RE) bouts comprised of different combinations of the acute program variables. METHODS: Four resistance training protocols were chosen based on their differential interaction with force production: high power (PWR, 6×3 squat jumps at 30% of 1RM); high force (FORCE, 6×3 squat at 95% of 1RM); high volume (oL, 6×10 at 80% of their 1RM); and a control day (CTRL, 6 sets of unracking an empty bar). To control for the rate of adaptation, only highly trained male subjects (years of training: 6+/-1 yrs; squat 1RM: 174+/-26 kg; age: 22+/-3 yrs; body mass: 84.76+/-9.86 kg; n = 7) were included in this study. Cortical activity was measured using an Ag-AgCl electrode-cap, a 40-channel monopolar digital amplifier, and an expanded International 10-20 electrode placement. Linked-ears reference, a ground scalp electrode, and eye electrodes were used to account for electrical artifacts (facial contractions). Movement artifacts were removed using a spatial filter. A 32-bit analog-to-digital converter was used to digitize signals at a sampling rate of 1000hz. High and low frequency bandpass was set at DC and 100hz respectively and signals were low-pass filtered at 50hz using an Infinite Impulse Response (IIR) recursive filter set to a roll-off of 12dB/oct. Pearson product-moment correlation coefficients were determined for selected pair wise variables. One-way and univariate analyses of variance (ANOVA) with repeated measures and Fisher's LSD post-hocs were used to detect significant mean differences. Significance level in this study was set at a 0.05 alpha level. RESULTS: Digital EEG techniques provided visual maps of the motor related cortical potential activity (MRCP) during each repetition of exercise. MRCP alterations were observed in all RE protocols when compared to CTRL, but our findings were not confined to the motor cortex. Each protocol was accompanied by specific yet characteristic MRCP patterns. As expected, the CTRL protocol was accompanied by little activity that was diffusely spread. Integral mapping showed activity increases in PWR, FORCE, and oL. These changes were primarily seen in prefrontal, central, posterior parietal, and occipital cortical regions, although the magnitude and temporal characteristics of activity appeared to vary. Therefore, the primary finding of this investigation was that, as assessed by high density EEG, cortical activity during maximal exertion resistance exercise incorporating large amounts of muscle mass in highly trained males is specific to the physical characteristics of movement and global in nature. CONCLUSIONS: In the present study, the visual maps of motor related cortical potential suggest that the differing domains of resistance exercise are characterized by unique topographical characteristics. PRACTICAL APPLICATIONS. The finding that different exercise domains are stimulated by unique cortical output signifies the importance of the acute program variables to physical development in trained men. Based on the images we were able to produce, it is possible that the concept of the size principle is reflected in distinct patterns at the level of the motor cortex. The role of the central nervous system in the control of physiological function cannot be underestimated, and this study should be placed appropriately within the context of this evolving area of research. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Perception of effort is a key factor in understanding the strain and stress of an exercise bout. The purpose of this study is to examine the relationships among ratings of perceived exertion (RPE), heart rate (HR), load used, among each set and with a total resistance exercise workout. METHODS: 137 untrained healthy subjects (consisting of 81 men [(mean ± standard deviation) age 22 ± 4.1, weight 81 ± 13.9kg, and height 180 ± 6.7cm] and 56 women [age 23 ± 3.7, weight 65 ± 11.4kg, and height 163 ± 7.1cm]) volunteered for the study and completed a 1 repetition maximum (1RM) strength test and acute resistance exercise test (ARET). The ARET consisted of 6 sets of 10 repetitions using a Smith-squat within a computerized ballistic power system (Lismore, Australia) at 60% of their 1RM, with 2 minutes of rest between each set. HR and RPE were obtained after each set. The load was adjusted to complete each 10 repetition set. Subjects gave RPE ratings using the Borg CR-10 with magnitude estimation scale. Significance was set at P ≤ 0.05. RESULTS: Heart rate and RPE significantly increased for every set of the ARET in both men and women. For the total workout no apparent sex-related differences occurred. For the whole workout there were significant (P < 0.05) correlations between: set & HR (α = .000, r = .331), set & RPE (α = .000, r = .662), HR & Load (α = .040, r = -.073), HR & RPE (α = .000, r = .291), and Load & RPE (α = .000, r = -.131). For individual sets a different pattern was observed. Set 1: No significant relationships found among HR, load, or RPE. Set 2: No significant relationships found among HR, load, or RPE. Set 3: HR & RPE (α = .041, r = .177) and Intensity & RPE (α = .037, r = -.179) were significant. Set 4: HR & RPE (α = .028, r = .190) were significant. Set 5: HR & Load (α = .021, r = -.201) were significant. Set 6: Load & RPE (α = .009, r = -.228) were significant. CONCLUSIONS: In a squat resistance exercise protocol, a low degree of the shared variance is explained with any of the variables measured in this study. This relationship is even worse when one examines individual sets. Thus, the use of RPE in untrained individuals during a resistance exercise protocol only explains the actual stress they are experiencing during the workout. This may be due to the intermittent nature of the exercise stress and differences in the recovery capability in untrained individuals. PRACTICAL APPLICATIONS: Surprisingly in a large group of untrained subjects, RPE using the CR-10 scale should not be used as a singular measure of exercise stress and should be used as part of a group of stress indicators (e.g., HR, exercise technique, repetition speed) to determine the fatigue status of an untrained subject performing resistance exercise. [ABSTRACT FROM AUTHOR]

Background: The efficacy of carotid endarterectomy in patients with asymptomatic carotid stenosis has not been confirmed in randomized clinical trials, despite the widespread use of operative intervention in such patients. Methods: We conducted a multicenter clinical trial at 11 Veterans Affairs medical centers to determine the effect of carotid endarterectomy on the combined incidence of transient ischemic attack, transient monocular blindness, and stroke. We studied 444 men with asymptomatic carotid stenosis shown arteriographically to reduce the diameter of the arterial lumen by 50 percent or more. The patients were randomly assigned to optimal medical treatment including antiplatelet medication (aspirin) plus carotid endarterectomy (the surgical group; 211 patients) or optimal medical treatment alone (the medical group; 233 patients). All the patients at each center were followed independently by a vascular surgeon and a neurologist for a mean of 47.9 months. Results: The combined incidence of ipsilateral neurologic events was 8.0 percent in the surgical group and 20.6 percent in the medical group (P<0.001), giving a relative risk (for the surgical group vs. the medical group) of 0.38 (95 percent confidence interval, 0.22 to 0.67). The incidence of ipsilateral stroke alone was 4.7 percent in the surgical group and 9.4 percent in the medical group. An analysis of stroke and death combined within the first 30 postoperative days showed no significant differences. Nor were there significant differences between groups in an analysis of all strokes and deaths (surgical, 41.2 percent; medical, 44.2 percent; relative risk, 0.92; 95 percent confidence interval, 0.69 to 1.22). Overall mortality, including postoperative deaths, was primarily due to coronary atherosclerosis. Conclusions: Carotid endarterectomy reduced the overall incidence of ipsilateral neurologic events in a selected group of male patients with asymptomatic carotid stenosis. We did not find a significant influence of carotid endarterectomy on the combined incidence of stroke and death, but because of the size of our sample, a modest effect could not be excluded. (N Engl J Med 1993;328:221-7.) [ABSTRACT FROM AUTHOR]